Buzzy®, a cognitive-Behavioral intervention package, and a kaleidoscope for reducing pain, fear, and anxiety during subcutaneous injections in children with Cancer: A three-arm randomized controlled trial.
TL;DR
Buzzy® may be useful when injection pain is the primary concern; CBIP and kaleidoscope are reasonable alternatives when nonpharmacological procedural support is desired.
Abstract
Purpose
To compare the effects of Buzzy®, a cognitive-behavioral intervention package (CBIP), and a kaleidoscope on pain (primary outcome), fear, and anxiety during subcutaneous injections in children with cancer.
Design
AND
Methods
This three-arm randomized parallel trial was conducted at a university pediatric oncology clinic in Türkiye from December 2024 to September 2025. Forty-five children aged 6-12 years were randomized 1:1:1 to Buzzy®, CBIP, or kaleidoscope groups. Post-injection pain was assessed using the Wong-Baker Faces Pain Rating Scale. Fear and state anxiety were assessed before and immediately after injection using the Children's Fear Scale and Children's Anxiety Scale-State, respectively, through child self-report and researcher ratings.
Results
Fear decreased significantly in all groups in child self-reports and researcher ratings, without between-group differences. Researcher-rated anxiety decreased significantly with Buzzy® and CBIP but not kaleidoscope; child-reported anxiety decreased significantly in all groups. Between-group anxiety differences were nonsignificant. Child-reported post-procedural pain was significantly lower with Buzzy® than with CBIP, whereas researcher-rated pain was significantly lower with Buzzy® than with both CBIP and kaleidoscope.
Conclusions
Fear decreased in all three groups, without clear superiority for fear or anxiety. Buzzy® was associated with lower pain ratings in specific comparisons. Findings warrant caution because this small, single-center trial compared three active interventions without a standard-care control group. PRACTICE IMPLICATIONS Intervention selection may reflect children's needs and preferences. Buzzy® may be useful when injection pain is the primary concern; CBIP and kaleidoscope are reasonable alternatives when nonpharmacological procedural support is desired.